Provider Demographics
NPI:1588497366
Name:IMMUNOBRIDGE MEDICAL GROUP, PLC
Entity type:Organization
Organization Name:IMMUNOBRIDGE MEDICAL GROUP, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-299-3129
Mailing Address - Street 1:6055 PRIMACY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5514
Mailing Address - Country:US
Mailing Address - Phone:901-299-3129
Mailing Address - Fax:
Practice Address - Street 1:6055 PRIMACY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5514
Practice Address - Country:US
Practice Address - Phone:901-299-3129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology